Can a disc bulge cause lower back pain?
Lower back pain may be attributed to many different structures within our back including muscles, bones, or ligaments. One of the common structures that may cause pain (around 28-40%) (Fukui et al., 2013) are the discs that sit between our spinal (vertebra) bones. The intervertebral discs sit between each spinal bone and function to protect our spine to withstand load and absorb shock. Discogenic lower back pain is a condition that arises due to pain coming from our intervertebral discs and can occur at any level – however lower / lumbar spine pain is most common due to the high load this part of our spine takes.
What causes this condition?
Discogenic lower back pain is because of mechanical, or chemical changes / damage to intervertebral discs (García-Cosamalón, 2010). It can result slowly over time (Ramsook & Bryce, 2018), and is often due to age related, degenerative changes that occur to the discs. It may also arise acutely (Ramsook & Bryce, 2018), in the case of an event / force that puts the discs under pressure that exceeds the capacity to withstand the load. Common examples of these traumatic events include lifting a heavy weight in a bent over position, standing back up and feeling a sharp pain, or a dull ache the following day. On rare occasions, people have reported their pain beginning after a big sneeze or a cough that causes an increased pressure on the spine, and damage to a disc.
Define any conditions that may be related to this condition as well?
Other conditions that may relate to discogenic lower back pain involve other structures in the area including facet joint pain (the joints either side of our discs) or muscles strain and associated pain related to tissue loading issues (for example, lifting heavy weight with muscles that aren’t strong enough to tolerate the load). Commonly, discogenic related pain may also be accompanied by nerve involvement, which may include symptoms that run down the legs (Ramsook & Bryce, 2018).
Common symptoms / signs
Common symptoms or signs that may indicate pain related to the discs within the spine are a constant, dull, ache-ey pain that is central or on both sides of our lower back. Pain may also extend down the leg (Ramsook & Bryce, 2018). Movements that provoke people’s pain are usually long periods of sitting, along with bending forward or standing up from a seated / curved position (Ramsook & Bryce, 2018). As mentioned above, coughing, or sneezing or taking big breaths may provoke someone’s pain. Over the coming weeks, pain may reduce centrally and pop up elsewhere – in areas that have had to work harder or compensate for the lower back injury, for example in the glutes.
How is it treated?
Management of discogenic lower back pain will usually begin with treating people in the positions that relieve the pain. Most of the time this is in an extension or arching back position (opposite to the bending over, painful position) (Adams et al., 2000). Stretches such as cobra pose may be prescribed initially. Treatment will progress based on the assessment conducted by a Physiotherapist to determine areas of limitation or weakness in the body that may contribute to a more vulnerable spine. For example, the glute and core muscles are very important in supporting the spine, and without the support, greater load and stress is placed on and relied upon by the passive structures of our spine including our intervertebral discs. Therefore, strengthening weaker muscles will help reduce this load and prevent future injury from occurring!
Adams, M. A., May, S., Freeman, B. J., Morrison, H. P., & Dolan, P. (2000). Effects of backward bending on lumbar
intervertebral discs: relevance to physical therapy treatments for low back pain. Spine, 25(4), 431-438.
Fukui, S., Nitta, K., Iwashita, N., Tomie, H., Nosaka, S., & Rohof, O. (2013). Intradiscal pulsed radiofrequency for
chronic lumbar discogenic low back pain: a one year prospective outcome study using discoblock for diagnosis. Pain Physician, 16(4), E435-E442.
García‐Cosamalón, J., Del Valle, M. E., Calavia, M. G., García‐Suárez, O., López‐Muñiz, A., Otero, J., & Vega, J. A.
(2010). Intervertebral disc, sensory nerves and neurotrophins: who is who in discogenic pain?. Journal of anatomy, 217(1), 1-15.
Ramsook, R. R., & Bryce, T. N. (2017). Degenerative Disc and Discogenic Pain. In Musculoskeletal Sports and Spine
Disorders (pp. 439-441). Springer, Cham.